paediatric operative dentistry

Paediatric operative dentistry Restorative considerations & current concepts

Presented by Dr. Akash Ardeshana Dept of Paedodontics and Preventive Dentistry Paediatric operative dentistry Restorative considerations & current concepts

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Content IntroductionHistoryObjectives EpidemiologyindicationImportance of primary teethPrimary v/s permanent teethClassificationsArmamentariumPrinciples of cavity preparationBibliography

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Introduction Operative dentistry is the art and science of the diagnosis, treatment, and prognosis of defects of teeth that do not require full coverage restorations for correction. Such treatment should result in the restoration of proper tooth form, function, and esthetics while maintaining the physiologic integrity of the teeth in harmonious relationship with the adjacent hard and soft tissues, all of which should enhance the general health and welfare of the patient. - Sturdevant Operative dentistry is a subject that deals with the diagnosis, prevention and treatment of problems and conditions of natural teeth, both vital and non vital, so as to preserve the natural dentition and restore it to the best state of teeth, function and esthetics. - Gilmore 3

History Early dentists- barbersLater, cavity preparation and tooth restoration became widely popular.The first successful tooth restorations were developed in the United States.G.V.Black (1924) Father of operative dentistryCharles E. Woodbury, E.K. Wedelstaedt, Waldon . Ferrier, and George Hollenback made significant contributions to the early development of operative dentistry.

M.E.J.Curzon, J.F.Roberts, D.B.Kennedy.Kennedys Paediatric Operative Dentistry.4th edition. Reed publishing house;1996.4

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Objectives (AAPD)To repair or limit the damage from caries, To protect and preserve the tooth structure,To reestablish adequate function, restore esthetics (where applicable), To provide ease in maintaining good oral hygienePulp vitality should be maintained whenever possible

AAPD Guideline On Restorative Dentistry. American Academy Of Pediatric Dentistry . V 36 / NO 6 14 / 155

Epidemiology M.E.J.Curzon, J.F.Roberts, D.B.Kennedy.Kennedys Paediatric Operative Dentistry.4th edition. Reed publishing house;1996.6

indication

Nikhil Marwah. Textbook of Pediatric Dentistry.3rd edition. Jaypee Brothers Medical Publishers Private Limited;20147

Importance of primary teethMasticationImpairment of speechEstheticsMaintenance of arch lengthPrevents development of oral habitsPrevent associated psychological effects


Primary v/s permanent

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General considerations 20 in number More white in color

MorphologicalConsiderations (crown )Smaller and Bulbous crowns Crowns are wider mesiodistally

General considerations32 in numberDarker, yellowish in color

Morphologicalconsiderations (crown )Crowns are wider Crowns are wider occlusogingivally

M. S. Duggal,M. E. J. Curzon,S. A. Fayle,K. J. Toynba. Restorative Techniques in Paediatric Dentistry: An Illustrated Guide to the Restoration of Extensive Carious Primary Teeth.2nd edition. CRC Press:2002.

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Narrow bucco-lingual occlusal table.

Mamelons are absent

Contact areas in primary teeth Broader, flatter, situated farther gingivally Occlusal table is not narrow

Mamelons are present

Contact points in permanent teeth are placed more occlusally


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Primary v/s permanent Enamel is thin, (1mm) Dentin thickness between pulp and enamel is less hence: Caries progress is faster. Chances of pulpal exposure are more

Enamel rod orientationMore thicker than the primary teeth

Dentine thickness is uniform

Enamel rod orientation

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Roots are long and slender

Roots have short trunk

They are more divergent and flaring

Undergo physiologic resorption Roots are short and robust

Large undivided portion of root is seen

They are less divergent and do not flare Only pathologic changes are seen13

Classifications G.V.Blacks classification

Class 1 - All pit and fissure lesions on occlusal surfaces of premolars and molars, lesions on the occlusal 2/3rds of facial and lingual surfaces of molars, and lesions on the lingual surfaces of maxillary incisors

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Class 2 Lesions on the proximal surface of the posterior teeth

Theodore M. Roberson, Harald 0. Heymann Edward J. Swift, Jr.Sturdevants Art and Science of Operative Dentistry. 4th edition. St. Louis: Mosby; 2002.

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Class 3 Lesions on the proximal surface of the anterior teeth without involving the incisal edge


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Class 4 Lesions on the proximal surface of the anterior teeth involving the incisal edge


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Class 5 Lesions on the gingival third of the facial or lingual surfaces of all the teeth


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Class 6 Lesions on the incisal edge of the anterior teeth or the occlusal cusp tips of posterior teeth (Simons modification)


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Finns modification

Class I: cavities involving the pits and fissures of the molar teeth and the buccal and lingual pits of all teeth.Class II: cavities involving proximal surface of molar teeth with access established from the occlusal surface.Class III: cavities involving proximal surfaces of anterior teeth which may or may not involve a labial or a lingual extention.


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Class IV: Cavities of the proximal surface of an anterior tooth which involve the restoration of an incisal angle.Class V : Cavities present on the cervical third of all teeth including proximal surface where the marginal ridge is not included in the cavity preparationM. S. Duggal,M. E. J. Curzon,S. A. Fayle,K. J. Toynba. Restorative Techniques in Paediatric Dentistry: An Illustrated Guide to the Restoration of Extensive Carious Primary Teeth.2nd edition. CRC Press:2002.

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Sturdevants classification:

CAVITY FEATURESimple cavityA cavity involving only one tooth surfaceCompound cavityA cavity involving two surfaces of a toothComplex cavityA cavity involves more than two surfaces of a tooth.


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Mount and Humes classification:

Site 1- pit and fissure on occlusal surfacesSite 2- proximal areas below contact pointSite 3- cervical 1/3rd of the crown


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Mount and Humes classification:

Size1- minimal involvement of dentinSize 2- moderate involvement, remaining tooth structure strong enough to support restorationSize 3- large cavity with weakened tooth structureSize 4- extensive caries with loss of bulk of tooth structure


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Armamentarium G.V.Blacks classification:Cutting instruments

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Armamentarium Condensing instruments

Hand pluggers Mechanical pluggers

Theodore M. Roberson, Harald 0. Heymann Edward J. Swift, Jr.Sturdevants Art and Science of Operative Dentistry. 4th edition. St. Louis: Mosby; 2002.Nikhil Marwah. Textbook of Pediatric Dentistry.3rd edition. Jaypee Brothers Medical Publishers Private Limited;2014

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Armamentarium Plastic instrumentsSpatulasCarriersCarversPlastic filling instruments Burnishers Finishing and polishing instruments

Hand Rotary Orangewood sticks Finishing burs Polishing points Mounted brushes Finishing strips Rubber cups and discs


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Armamentarium Isolation instruments Rubber dam kitSaliva ejectorCotton rollsHigh volume ejector Miscellaneous instruments Mouth mirrorsProbesPliersCotton tweezers


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Armamentarium Marzouks classification:


MatricesIt is thereby used as a temporary wall, which is created opposite to the axial walls, surrounding areas of the tooth structure that were lost during cavity preparation.Matrix is a device used during the restorative procedures to hold the plastic restorative material within the tooth while it is setting. 30

MatricesClassification:Place of applicationPosterior T-Band, ToffelmireAnterior Celluloid matrix Constituents Metallic Ivory no.1, Ivory no.8Non metallic Mylar strips Presence / absence of retainerWith retainer Ivory no.1, Ivory no.8Without retainer S-band 31

MatricesForm Anatomical Celluloid crown formNon anatomical Ivory no.1Use Universal Ivory no.8, ToffelmireUnilateral Ivory no.1

Edwina A. M. Kidd, Bernard G. N., Smith Timothy F, Watson H. M, Pickard. Pickards Manual of Operative Dentistry.8th edition. Oxford: University Press; 2003

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MatricesRecent modifications of matrixSectional matrixEasy to place, gives a large preparation area and reduces working timeMesial and distal proximal area restorations can be accomplished by one matrixSmartview matrixComes with smartband sectional matrices and titanium instrumentsNon stick surfaces, anatomical contoursMostly used for composite restorations


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Types of matrices used for tooth restorationMatrices for class I cavity (compound cavity)Double banded tofflemire Matrices for class II Single band tofflemireIvory matrix no.1Ivory matrix no.8Blacks matricesSoldered band or seamless copper band matrixAnatomical matrixAuto matrixS-shaped matrixT-shaped matrix

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Types of matrices used for tooth restorationMatrices for cavity preparation for amalgam on distal surface of cuspidS- shaped matrixTofflemireMatrices for class III tooth colored restorations Celluloid stripsMatrices for class IV tooth colored restorationsCelluloid stripsAluminium foilTransparent crown form matricesAnatomic matrixModified S-shaped band of copper, tin, aluminium

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Types of matrices used for tooth restorationMatrices for class V amalgam restorationsWindow matrixS-shaped matrixMatrices for classV tooth colored restorationsAnatomic matrixAluminium or copper collarsCelluloid strips

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Matrices

Sectional matrix Smart view matrix system 37

WedgesIt is defined as a piece of wood, metal etc. one end of which is an acute angled edge formed by two converging planes used to tighten or exert force in various ways.1883- wedges of boxwood, orangewood, balsam wood were made.1st metal wedge- Ottolengui steel wedge.Current wedges plastic, metal, wood, celluloidRecent wedges Luci-wedge, Hawe-Neos dental Edwina A. M. Kidd, Bernard G. N., Smith Timothy F, Watson H. M, Pickard. Pickards Manual of Operative Dentistry.8th edition. Oxford: University Press; 2003

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WedgesTypes Acc. to anatomyAnatomical in shape of embrassuresNon- anatomical roundAcc. to material usedWooden hard wood or soft woodPlastic in various shapesAcc. to colorColored Light reflecting used with composite


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Isolation Rubber dam:1864 Sanford Christie Barnum1882 SS White introduced a rubber dam punch, Dr.Doleus Palmer introduced set metal clamps.

Euphesisms Raincoat HangerClip 40

Armamentarium:

Rubber dam sheet Frame Rubber dam punchClamps Rubber dam retaining forceps Edwina A. M. Kidd, Bernard G. N., Smith Timothy F, Watson H. M, Pickard. Pickards Manual of Operative Dentistry.8th edition. Oxford: University Press; 2003

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Procedures for rubber dam placement:

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Recent advances in rubber dam

Articulated frame.Safe T frame45

Recent advances:Quick dam or insta damOptra damSplit dam technique

Optra dam

Insta dam Edwina A. M. Kidd, Bernard G. N., Smith Timothy F, Watson H. M, Pickard. Pickards Manual of Operative Dentistry.8th edition. Oxford: University Press; 2003

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Handi damDry dam.Insti dam47

Opti dam.Optra dam.48

Super clampLong guard extension clampTiger clamp

Cushees49

Recent alternatives to Rubber Dam

Kool dam (Pulpdent Corporation)

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Provides hands-free evacuation, retraction, and safety shielding, as well as illumination

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Fast dam52

Title Efficiency and patient satisfaction with the Isolite system versus rubber dam for sealant placement in pediatric patients.

AuthorsAlhareky MS1, Mermelstein D2, Finkelman M3, Alhumaid J4, Loo C2.Pediatr Dent. 2014 Sep-Oct;36(5):400-4.Level of evidencellA Aim The purpose of this clinical study was to compare the chair time and degree of patient satisfaction after use of the Isolite system (IS) versus rubber dam (RD) during the application of pit and fissure sealants.

Materials and methodsThe patients included in this study ranged from seven to 16 years old. In each subject, pit and fissure sealants were applied to one permanent molar in each quadrant. IS dental isolation was used on one side; RD isolation was used on the other side. Chair time was assessed using a stopwatch, and patient acceptance was evaluated using a questionnaire.

ResultForty-two subjects (23 females and 19 males) were enrolled in the study. The average chair time was 19.36 minutes for the application of pit and fissure sealants on the RD side; average chair time was 10 minutes for the IS side (P

paediatric operative dentistry

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